Promoting Patient-Centered Counseling to Reduce Inappropriate Diagnostic Tests

University of California (UC) Davis

Status: Completed

Conditions: Osteoporosis; Unnecessary Procedures; Primary Care; Headache; Magnetic Resonance Imaging; Low Back Pain

Treatments: Behavioral: Control; Behavioral: Standardized Patient Instructor Intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT01808664

364498-3 (Other Identifier)

364498

Details and patient eligibility

About

In this study, the investigators will develop and evaluate a novel intervention using standardized patients (SPs) -- or actors playing the roles of patients -- to enhance physicians' patient-centered counseling skills regarding two frequently overused, potentially inappropriate services in primary care: magnetic resonance imaging (MRI) for acute low back pain and bone densitometry in women at low-risk for osteoporosis. The investigators will further evaluate whether intervention effects on physician patient-centeredness generalize to counseling regarding other costly, unnecessary diagnostic tests.

Enrollment: 61 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Resident physician in family medicine or internal medicine who deliver primary care at one of two hospital-based primary care clinics at the University of California, Davis Medical Center Sacramento

Exclusion criteria

• Anticipated graduation in less than one year from enrollment.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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61 participants in 2 patient groups

Standardized Patient Instructor Intervention

Experimental group

Description:

Primary care physicians (PCPs) randomized to intervention will receive over a three month run-in period two visits by standardized patient instructors portraying: 1) a 48 year-old patient with low back pain for less than six-weeks and no "red flags" for immediate spinal imaging; and 2) a 50 year-old recently menopausal woman establishing care with concerns about osteoporosis risk.

Treatment:

Behavioral: Standardized Patient Instructor Intervention

Control

Active Comparator group

Description:

In the latter half of visits with control PCPs, standardized patient instructors (SPIs) will share information regarding low back pain or bone health that are unrelated to diagnostic testing, but will not discuss patient-centered techniques or conduct training. The total duration of the control "information sharing" will be about one-third the SPI intervention to enhance patient-centeredness.

Treatment:

Behavioral: Control